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State of California—Environmental Protection Agency Seg [16 ruc 10 _ - - Sacramento, n 1 or ._l'
<br /> Form Approved OM8'No.205D-0039{expires 9'30'9,4] _ 2 Paga 1 Information in the shaded areas
<br /> Please print or type. Form designed for use on elite(1' pit4h] -i'iter. " Manifest Document N' not required by Federal law,
<br /> ,erato,,,US EPA ID No. `
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<br /> + O 15 Special Handling Instructions and Additional information - - - a 4C Y RESPOI
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<br /> 15 marked,aOnd'S CERTIFICATION and?ra ollnarniiand
<br /> respyectscin proper condition tforftha_nsport by highway according torappli able internal onalyand notion
<br /> oti nal go a nment regulations.
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<br /> If l am a large quantiryh generator,I certify that Lha"a program in,place to reduce the vokume and toxicity le to to generated to the degree I have determined ro be econamica y
<br /> practica6le anod t ctrl OR @ifs(am d sma9lrquaica6l generator o,Elt eat nt,sta good faith effort Corm nim ie rey waste generme ioG nia d 3electetfpe best s�ntwa�teumanag went method ha I is
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<br /> r t except as noted in Item 19.
<br /> I: E n of receipt t of hazardous materials covered b this monifes
<br /> Facili Owner or O erator Certificatio c S, aerate Month Day Year
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<br /> I DO NOT WRITE BELQW THIS LINE.
<br /> Yellow: GENERATOR RETAINS
<br /> DTSC 8022A(1/99);- EPA 8700-22
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